New York State Department of Taxation and Finance                                         For office use only

                  Real Estate Transfer Tax Claim for Refund

Name of claimant                                                               Name of representative or person to contact                          Telephone number
                                                                                                                                                    (    )
      Social security number         Employer identification number            Firm name, if applicable

Address of claimant                                                            Address of person to contact 

City, village or post office                         State  ZIP code           City, village or post office                                         State     ZIP code

Location of property conveyed (list each lot separately; attach additional sheets if necessary)
Address                                                                                                                                             County

Address                                                                                                                                             County

Date of transfer (mm/dd/yyyy)

                                                   1 Amount of tax paid by claimant/assignor  .....................................               1.
Refund assignment: If the refund 
is to be paid to someone other than                2  Amount of tax due  ........................................................................ 2.
the person primarily liable for the 
tax, mark an  Xin this box and see 
instructions on back  ...........................  3 Refund requested(subtract line 2 from line 1)  ..................................            3.

Explanation: Give a full explanation below, including all facts on which your claim is based. Attach additional pages if necessary, and submit a copy 
of all documentation necessary to substantiate your claim. In addition, if the Form TP-584, Combined Real Estate Transfer Tax Return, Credit Line 
Mortgage Certificate, and Certification of Exemption from the Payment of Estimated Personal Income Tax, was filed with a recording officer rather 
than directly with the Tax Department, submit a copy of the receipt provided by the recording officer at the time of payment.

Certification: I,                                                    , the claimant named above, or partner, officer, or other authorized 
representative of the claimant, certify that the information contained in this claim is true and correct to the best of my knowledge, that no prior claim 
for a refund of the whole or any part of the amount on line 3 has been filed, and that no part has previously been refunded to the claimant or any 
assignee, except as specified herein.
  Signature                                                         Title or relationship to claimant                                                     Date

TP-592.2 (4/13)

TP-592.2 (4/13) (back)
                                                           Instructions

Who must file this form                                                        Privacy notification
Any person(s) claiming a refund of the real estate transfer tax paid           The Commissioner of Taxation and Finance may collect and maintain 
pursuant to Tax Law Article 31 must file this form within two years from       personal information pursuant to the New York State Tax Law, including 
the date of payment.                                                           but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 
                                                                               697, 1096, 1142, and 1415 of that Law; and may require disclosure of 
Person to contact                                                              social security numbers pursuant to 42 USC 405(c)(2)(C)(i).
Please note that any person named as the person to contact on this             This information will be used to determine and administer tax liabilities 
form may be contacted for purposes of obtaining additional information.        and, when authorized by law, for certain tax offset and exchange of tax 
However, naming a contact person does not constitute granting power            information programs as well as for any other lawful purpose.
of attorney, and we will not disclose information to that person solely 
because they have been listed as a contact. If you wish a representative       Information concerning quarterly wages paid to employees is provided 
to have such authority, you must complete and submit Form POA-1,               to certain state agencies for purposes of fraud prevention, support 
Power of Attorney.                                                             enforcement, evaluation of the effectiveness of certain employment and 
                                                                               training programs and other purposes authorized by law.
Person primarily liable for tax
                                                                               Failure to provide the required information may subject you to civil or 
Real estate transfer tax (Form TP-584, Part I, line 6)                         criminal penalties, or both, under the Tax Law.
The person primarily liable for the payment of the basic tax is the            This information is maintained by the Manager of Document 
grantor. If the grantor fails to pay or is exempt, the liability shifts to the Management, NYS Tax Department, W A Harriman Campus, 
grantee.                                                                       Albany NY 12227; telephone (518) 457-5181.
Additional tax (Form TP-584, Part II, line 3)
                                                                                  
The person primarily liable for the payment of the additional tax is the       Need help?
grantee. If the grantee is exempt, the liability shifts to the grantor.
                                                                                          Visit our Web site at www.tax.ny.gov
Refund assignment                                                                         •  get information and manage your taxes online
When a refund is to be paid to someone other than the person primarily                    •  check for new online services and features
liable for the payment of the tax, you must submit an acknowledged 
assignment or an affidavit executed by the person primarily liable that                   Telephone assistance
clearly:
•  states the purpose for assigning the refund,                                Mortgage and Transfer Tax Information Center:  (518) 457-8637
•  describes the subject matter of the assignment with such particularity      To order forms and publications:                  (518) 457-5431
   as to render it capable of identification, and
•  states the unconditional intent of the person primarily liable to assign    Text Telephone (TTY) Hotline (for persons with 
   the refund.                                                                   hearing and speech disabilities using a TTY):  (518) 485-5082
                                                                                          Persons with disabilities: In compliance with the Americans 
Where to file                                                                             with Disabilities Act, we will ensure that our lobbies, offices, 
Mail your claim to: NYS TAX DEPARTMENT                                                    meeting rooms, and other facilities are
                    TDAB - REAL ESTATE TRANSFER TAX                            accessible to persons with disabilities. If you have questions about 
                    W A HARRIMAN CAMPUS                                        special accommodations for persons with disabilities, call the 
                    ALBANY NY 12227                                            information center.
Private delivery services
If you choose, you may use a private delivery service, instead of the 
U.S. Postal Service, to mail in your form and tax payment. However, 
if, at a later date, you need to establish the date you filed or paid your 
tax, you cannot use the date recorded by a private delivery service 
unless you used a delivery service that has been designated by 
the U.S. Secretary of the Treasury or the Commissioner of Taxation 
and Finance. (Currently designated delivery services are listed in 
Publication 55, Designated Private Delivery Services. See Need help? 
below for information on obtaining forms and publications.) If you 
have used a designated private delivery service and need to establish 
the date you filed your form, contact that private delivery service for 
instructions on how to obtain written proof of the date your form was 
given to the delivery service for delivery.

                                                                       For office use only
                             Audit report                                                                   Approval
Amount allowed                                                                 Approved for payment
$                                                                              $
Interest amount                                     Interest start date        Signature
$
Total refund                                                                   Title
$
Examiner                                            Date                       Date